Provider Demographics
NPI:1386728541
Name:ALLGOOD, JOHN T JR (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:ALLGOOD
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 I-49 SOUTH SERVICE ROAD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-942-2674
Mailing Address - Fax:337-948-1858
Practice Address - Street 1:4049 I-49 SOUTH SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-2674
Practice Address - Fax:337-948-1858
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA..A10008.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50160P160Medicare PIN